According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB 

control numbers for these information collections are 0579- 0020, 0036, 0048, 0101, 0156, 0278, and 0432. The times required to complete these information collections is estimated to average .25 to 1.5 hours per response, 

including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

OMB Approved

0579- 0020, 0036, 0048, 

0101, 0156, 0278, and 0432

Instructions for USDA Accredited Veterinarians: 

Filling Out International Health Certificates for Pets

Veterinary Authority

UNITED STATES DEPARTMENT OF AGRICULTURE

Certificate Number

1. Consignor: 2. Consignee:

3. Country Of Origin:

USA

4. State Of Origin:

5. Country Of Destination: 6. Zone Of Destination:

**********************************************************

7. Place Of Origin: 8. Port Of Embarkation / Border Crossing:

9. Estimated Date Of Shipment: 10. Means Of Transport:

12. CITES Permit Number:

**********************************************************

13. Description Of Commodity:

15. Total Quantity: 16. Additional Information:

17. Total Number Of Packages/Containers:

18. Identification / Seal Numbers:

19. Commodities Intended Use:

21. Identification Of Commodities: 

Page 1 of 3

Date Of Issue

Date you sign the health certificate Leave blank

Name and address of the

pet owner/exporter in the 

United States (U.S.)

U.S. state/territory where the pet currently resides

U.S. address where the pet currently

resides. This is not where the pet was 

born.

U.S. airport, sea port or land border port

from which the pet is leaving.

Date the pet will depart the U.S. How the pet is traveling to the destination country (e.g., airplane)

Country to which the pet will be moved

Type of pet (common versus scientific name may be required)

14. Date Of Inspection:

Date you examined the pet before issuing the health certificate

Number of pets certified on this health certificate Leave blank

The number of shipping containers for transporting the pets on the health certificate to the destination country.

The number located on the seal used to close the shipping container(s). If no seal is required, type "Not

Applicable."

Complete the required information in each column for every pet included on the health certificate.

The above information must match the corresponding information on supporting documentation (e.g., rabies 

vaccination certificate).

11. *******************************************************

Do not record information in fields with asterisks or line 

Name and address of the pet owner/

importer in the destination country

Must include the destination country's name

20. Type Of Admission:

How long the pet will reside in the destination country (e.g., 

permanent, temporary).

If this is pre-printed on the health certificate, do not 

change it.

How the pet will be used in the destination country

(e.g., as a pet).

If this is pre-printed on the health certificate, do not

change it.

You must complete all fillable fields. Do not complete fields with asterisks ( ) or diagonal line outs. Failure to accurately complete 

all required fields may delay endorsement by your USDA Endorsement Office.
Veterinary Authority

UNITED STATES DEPARTMENT OF AGRICULTURE

Certificate Number

Certification Statements: 

Page 2 of 3

Instructions for USDA Accredited Veterinarians: 

Filling Out International Health Certificates for Pets

Date of Issue

Date you sign the health certificate Leave blank

Certification statements like these do not require any additional information. By 

issuing the health certificate, you are declaring the statements are true for the 

animal. If a statement will not be true at the time you issue the health certificate 

or by the time the animal arrives in the destination country, do not issue the health 

certificate. 

You must select the applicable statement. If neither statement is true, do not 

issue the health certificate.

Certification statements may require you to record information about required 

vaccinations, testing, and treatment. You must record all the information the 

destination country requires. Do not provide information beyond what is 

required. If you do not have the required information and cannot obtain it, do 

not issue the health certificate.
Veterinary Authority

UNITED STATES DEPARTMENT OF AGRICULTURE

Certificate Number

Name of Accredited Veterinarian Name of USDA Veterinarian

Signature of USDA Veterinarian

Date

Page 3 of 3

Date Of Issue

Date you sign the health certificate Leave blank

Your printed name (typed or handwritten in ink)

Date you sign the health certificate

Leave blank for USDA Veterinary Medical Officer's endorsement

Date

Signature of Accredited Veterinarian

Your signature here 

Instructions for USDA Accredited Veterinarians: 

Filling Out International Health Certificates for Pets

** *********************************************************************************************

***********************************************************************************************

***********************************************************************************************

If the health certificate contains blank space at the end, do not record any information here.

Leave blank for USDA Veterinary Medical Officer's endorsement

Leave blank for USDA Veterinary Medical Officer's endorsement